Cognitive Intervention for Attention and Executive Function Impairments in Children With Traumatic Brain Injury: A Pilot Study.

OBJECTIVE: To test the effectiveness of the Attention Improvement and Management (AIM) program, a cognitive intervention for improving impairments in attention and executive functions (EFs) after pediatric traumatic brain injury (TBI). SETTING: Tertiary care children's hospital. PARTICIPANTS: A total of 13 children with complicated mild-to-severe TBI (average of 5 years postinjury) and 11 healthy comparison children aged 9 to 15 years completed the study. DESIGN: Open-label pilot study with a nontreated control group. MAIN MEASURES: Subtests from the Test of Everyday Attention-for Children (TEA-Ch) and the Delis-Kaplan Executive Function System (D-KEFS), the self- and parent-report from the Behavior Rating Inventory of Executive Function (BRIEF), and the Goal Attainment Scale (GAS). RESULTS: Relative to the healthy comparison group, children with TBI demonstrated significant improvement postintervention on a neuropsychological measure of sustained attention, as well as on parent-reported EFs. The majority of families also reported expected or more-than-expected personalized goal attainment. CONCLUSIONS: The study provides preliminary evidence for the effectiveness of AIM in improving parent-reported EFs and personalized real-world goal attainment in children with TBI.

Phase I evaluation of the television assisted prompting system to increase completion of home exercises among stroke survivors.

PURPOSE. Effective delivery of dysphagia exercises requires intensive repetition, yet many brain injury survivors demonstrate difficulty adhering to home programmes. The Television Assisted Prompting (TAP) system provides a novel method to deliver intensive in-home therapy prompts. Specific research questions compared the effectiveness of the TAP system to typical practice on programme adherence, satisfaction and caregiver burden. METHOD. A within-participant alternating treatment design with random assignment of treatment condition compared exercise programme adherence across TAP and typical practice delivery conditions, replicated across three participants. Data included quantitative programme completion rates, satisfaction survey reports and caregiver burden questionnaire results, as well as qualitative interview findings. RESULTS. A large treatment effect was demonstrated for two participants; exercise programme completion rates increased by 6-17 times typical practice levels with the TAP system. TAP supported sustained practice over the course of the experiment for the third participant despite minimal differences between conditions. Participants reported high satisfaction and endorsed the TAP system. There was no significant change in caregiver burden. CONCLUSION. The TAP system provided a novel assistive tool to support home programme completion of intensive exercise regimens for clients with cognitive impairment and care providers with significant burden. Future research must ensure continued development of a reliable and intuitive system.